Provider Demographics
NPI:1134472087
Name:PREMIER INFECTIOUS DISEASE CONSULTANTS LLC
Entity Type:Organization
Organization Name:PREMIER INFECTIOUS DISEASE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANUJA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-333-4500
Mailing Address - Street 1:PO BOX 290310
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0310
Mailing Address - Country:US
Mailing Address - Phone:636-333-4500
Mailing Address - Fax:
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:636-333-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty